tbuckley/cabot-search huggingface dataset:
The timing of statin initiation on survival outcomes of cancer patients treated with immune checkpoint inhibitors: A retrospective cohort study.
Authors: Xin Ya See, Cho Hsien Chiang, Cho Han Chiang, Yuan-Jen Chen, Yu-Cheng Chang, Shih-Syuan Wang, Chun-Yu Peng, Chuan-Sheng Horng, Yuanping Hsia, Cho Hung Chiang, Cheng-Ming Peng, Her-Shyong Shiah
Journal: Journal of Clinical Oncology (2023)

e14672 Background: Concomitant use of statins has been associated with improved survival outcomes in patients treated with immune checkpoint inhibitors (ICIs), but it is unclear if the timing of statin initiation plays a role in patient outcomes. We aimed to investigate the outcomes of patients who were started on a statin before and after initiation of ICI therapy. Methods: We performed a retrospective cohort study at two tertiary referral centers in Taiwan. We collected data on statin use including the timing of statin initiation, basic demographics, underlying comorbidities, and cancer information. We compared the overall survival (OS) and progression-free survival (PFS) between statin and non-statin users using Cox proportional hazard model analysis and Kaplan-Meier Survival analysis. Results: Among 734 patients who received ICIs, 76 patients received statins after ICI initiation, 52 patients received statins before ICI initiation, and 606 were non-statin users. Patients who received statins after ICI had a longer OS (median 37.6 vs. 11.3 vs. 10.3 months, p = 0.01) and PFS (median 10.5 vs. 5.6 vs. 6.3 months, p = 0.02) than patients who received statins before ICI and non-statin users. In Cox proportional hazard analyses, the use of statins after ICI was associated with a lower risk of mortality (HR, 0.65 [95% CI: 0.45-0.94], p = 0.02) or disease progression (HR, 0.71 [95% CI: 0.53-0.95], p = 0.02) compared with non-statin users. On the other hand, the use of statins before ICI was not associated with a lower risk of mortality (HR, 1.46 [95% CI: 0.96-2.22], p = 0.08) or disease progression (HR, 1.22 [95% CI: 0.86-1.73], p = 0.26) compared with non-statin users. These trends were observed in multivariate Cox proportional analyses adjusting for underlying comorbidities, cancer stage, type, and therapy. Conclusions: The use of statins after the initiation of immunotherapy is associated with improved survival outcomes. [Table: see text]
Polypectomy or excisional biopsy versus combination polypectomy or excisional biopsy with interventional radiology local tumor destruction for rectal cancer: A SEER database analysis.
Authors: Ashton Legenza, Michael Burdyny, Peter T. Silberstein, Connor Tupper
Journal: Journal of Clinical Oncology (2023)

e15658 Background: Rectal cancer is a common and potentially debilitating form of gastrointestinal cancer. Despite advances in surgical and systemic therapies, a significant proportion of patients present with locally advanced or recurrent disease. Interventional radiology (IR) has emerged as a crucial tool in the management of rectal cancer, offering a number of minimally invasive treatments aimed at locally destroying the tumor. This study aims to evaluate the efficacy and prognostic significance of combining IR treatments with polypectomy or excisional biopsy in the management of rectal cancer, compared to polypectomy or excisional biopsy alone. Methods: We queried the Surveillance, Epidemiology, and End Results (SEER) database for patients diagnosed with primary rectal cancer from the cecum to the sigmoid (primary site codes C209), including the appendix, diagnosed between 2000-2019. Patients were included if management of the primary tumor included either excisional biopsy, polypectomy, or local tumor destruction (LTD) via photodynamic therapy, electrocautery, cryosurgery, or laser ablation (surgical codes 21-24). Variables included for statistical analyses were age at diagnosis, sex, race, stage, and surgical management subtype status. Results: A total of 24309 patients were collected from this search of which 1437 patients were selected that had undergone a combination polypectomy or excisional biopsy with LTD, 15005 patients underwent polypectomy alone, 7481 patients underwent excisional biopsy alone, 386 patients underwent curette and fulguration. On Kaplan-Meier, combination treatment showed a worse mean survival than polypectomy alone (p &lt; 0.01). Combination treatment showed better mean survival than excisional biopsy alone ( &lt; 0.001). The combination treatment showed similar survivability to curette and fulguration. The one-, three-, and five-year survival rates of combination treatment were 98.5%, 95.8%, and 94.8%, respectively, which is significantly greater than excisional biopsy at all points but significantly worse than polypectomy alone at all time points (p’s &lt; 0.001). On Cox regression, combination treatment showed no difference in survival to polypectomy alone and curette fulguration. Combination treatment survival was significantly better than excisional biopsy alone (p &lt; 0.001). Additionally, older age (p &lt; 0.001), regional spread of tumor (p &lt; 0.001), and distant spread of tumor (p &lt; 0.0001) were all associated with worse survival outcomes. Conclusions: Combination polypectomy or excisional biopsy with IR LTD procedures are associated with improved survival compared to excisional biopsy alone for the treatment of rectal cancer. Our findings suggest that IR procedures may serve as an effective adjunct treatment option for primary rectal tumor management.
Characteristics of survivors with peritoneal mesothelioma.
Authors: Meri Muminovic, Shenae Samuels, Aja Erskine, Pablo H. Ferraro, Christopher J. Gannon, Omar H. Llaguna
Journal: Journal of Clinical Oncology (2023)

e16325 Background: Peritoneal mesothelioma (PM) is a rare, fatal malignancy. The aim of the study is to determine the clinical and sociodemographic characteristics associated with long-term survival (LTS). Methods: The 2004 - 2019 National Cancer Database was queried for patients with PM. LTS was defined as having survived at least 5 years following diagnosis. Univariate and multivariate logistic analyses were performed to identify characteristics associated with LTS. A nomogram predicting the likelihood of LTS was developed. Results: 3,636 patients were identified, of which, 18% experienced LTS. The median overall survival (OS) for the entire study population was 17.7 months. The median OS for the LTS cohort was 92 months and 11.7 months for non-long-term survivors (NLTS). In univariate analysis, LTS was more likely to occur in younger (&lt; 50 years), healthy (Charlson-Deyo = 0), female and privately insured patients that traveled farther for care, were treated at an academic or very high-volume center, had epithelial histology, underwent radical surgery and received chemotherapy (p &lt; 0.001). Interestingly, among those who were treated non-operatively, LTS was associated with a longer time-to-chemotherapy (LTS = 50 days, NLTS = 32 days, p &lt; 0.001). Although not statistically significant, among those who received surgery, results suggest that LTS was more likely achieved in those who received hyperthermic intraperitoneal chemotherapy (HIPEC) (p = 0.086). Patients who underwent surgery plus HIPEC experienced the longest median OS (65.9 months) when compared those who underwent surgery plus systemic therapy (38 months) or surgery alone (9.6 months) (p &lt; 0.001). Multivariate logistic regression analysis suggests that age, female gender, and surgical margins are independent predictors of LTS. Based on our nomogram, patients with favorable characteristics resulted in a total score of at least 19 and had an approximate 50% chance of LTS. Conclusions: Age, gender and surgical margins were found to be independent predictors of LTS. Additionally, our nomogram may help predict LTS among patients with PM.
Racial disparities and clinical outcomes among cancer patients admitted with SARS-CoV-2 infection: A nationwide analysis.
Authors: Vaishali Deenadayalan, Siri Chandana Swarna, Jay Vakil, Junglee Kim, Ekrem Turk, Shweta Gupta
Journal: Journal of Clinical Oncology (2023)

e18568 Background: The novel SARS COV2 pandemic highlighted existing racial disparities in US healthcare. The impact was further amplified in the cancer community. We studied the racial disparities in the clinical outcomes of cancer patients who were hospitalised with COVID-19 infection. Methods: Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS) 2020 was queried to identify adult patients (Age &gt; 18 years) admitted for COVID with underlying cancer using the ICD-10 codes. Study population was stratified based on race (White vs African Americans vs Hispanics). Primary outcomes included mortality, length of stay (LOS), and total hospitalization charges (THC). Secondary outcomes included prevalence of pulmonary embolism (PE), ICU admission, acute respiratory failure (ARF), blood transfusion, and sepsis. Statistics were performed using multivariate linear and logistic regression using STATA v17. Results: There were 53,465 adult admissions for COVID in cancer patients. Among them 30,605 (58.8%) were White (WH), 9580 (18.4%) were African Americans (AA), 8225 (15.8%) were Hispanics (HISP). HISP and AA were significantly younger compared to WH (61.7 vs 65.8 vs 72.4, p &lt; 0.001). HISP had lowest Charlson comorbidity index (CCI) compared to whites (50.4% vs 67.7%, p &lt; 0.001). AA had highest rates of all medical comorbidities except dyslipidemia and COPD which was higher in WH. Of the 8135 (15.2%) patients that died during the admission, 60% (N = 4880) were WH, 17.1% (N = 1390) were AA whereas 13.5% (N = 1100) were HISP. Compared to WH, HISP had a higher odds of mortality (aOR 1.24, 95% CI 1.03-1.48; p = 0.022), there was no difference in the odds of mortality between WH and AA. The LOS was increased for AA and HISP compared to WH (9.1 vs 9.44 vs 7.78 days, p &lt; 0.001). The total hospitalization charges was also higher for AA and HISP compared to WH ($90,680 vs $123,894 vs $74,126, p &lt; 0.001). HISP patients had higher odds of requiring intubation, blood transfusion, shock and sepsis than WH. Conclusions: Despite being significantly younger with lower comorbidity burden, HISP, had an increased odds of mortality compared to WH patients. Contrary to reported literature (PMID: 35344045), there was no significant difference in the odds of mortality between WH and AA. Further studies are needed to explore the reasons for high mortality in HISP patients. [Table: see text]
Guideline-concordant use of olanzapine as part of a 4-drug antiemetic regimen for high emetic risk chemotherapy across the state of Michigan.
Authors: Ashley Bowen, Emily R. Mackler, Kelly DeVries, Manlan Liu, Jennifer J. Griggs
Journal: Journal of Clinical Oncology (2023)

6519 Background: Chemotherapy-induced nausea and vomiting (CINV) is a feared side effect of cancer treatment. If not adequately controlled, CINV can negatively affect both quality of life and increase the costs of care. Clinical practice guidelines from both ASCO and NCCN recommend inclusion of olanzapine as part of a 4-drug antiemetic regimen in patients receiving high emetic risk chemotherapy (HEC). Uptake of olanzapine has been low, however, in part due to oncologists’ lack of familiarity with the medication, lack of awareness or agreement with the guidelines, and lack of olanzapine inclusion on prepopulated order sets. Current labeling of olanzapine as an antipsychotic poses an additional barrier. The purpose of this project was to increase guideline-concordant prescribing of olanzapine as part of a 4-drug antiemetic regimen in patients receiving HEC in practices that are part of the Michigan Oncology Quality Consortium (MOQC), a physician-led consortium of nearly 90% of oncologists in Michigan. Methods: In 2019, MOQC began measuring guideline-concordant HEC prophylaxis with a 4-drug regimen of olanzapine added to corticosteroids, a 5HT3RA, and an NK1RA as part of its measure set. A quality improvement intervention was initiated that consisted of 1) dissemination of baseline measure performance and regular reporting of practice and state-level performance to MOQC practices, 2) information support through sharing of guidelines at biannual meetings (2019, 2022) and state-wide CINV education to improve prescriber knowledge and beliefs and support the practices in updating prepopulated antiemetic order sets, and 3) addition of value-based reimbursement in 2021 to encourage practice change. Measure performance was assessed using ASCO’s Quality Oncology Practice Initiative (QOPI) program. Results: The patient sample included 5,703 patients. MOQC practices increased the guideline-concordant prescribing of olanzapine as part of a 4-drug antiemetic regimen in patients receiving HEC round over round from R1 2019 to R1 2022 (p&lt;0.0001). Conclusions: MOQC has facilitated increased use of olanzapine as part of a 4-drug antiemetic regimen in patients receiving HEC through practice education, reporting, and value-based reimbursement. Ongoing work will focus on practices with low uptake and on demonstrating the impact of this important practice change on patient outcomes. [Table: see text]
Variations in the approach to lung metastases in osteosarcoma among pediatric and adult patients.
Authors: Victoria A Wytiaz, John Rice, Rama Rao, Scott Schuetze, Andrew C. Chang, Rishindra M Reddy, Christina Vadala Angeles, Rashmi Chugh
Journal: Journal of Clinical Oncology (2023)

11528 Background: Osteosarcoma (OS) is most common in the pediatric (ped) and young adult population but can occur at any age. Amongst other factors, older age confers a worse prognosis, and it is uncertain whether this is due to inherent biologic differences or treatment approaches. Lung-only metastases (mets) is common, and metastasectomy is performed frequently to improve overall survival. Little is known about the differences in lung-only metastatic OS and approaches to metastasectomies between ped and adult populations. Methods: A single-institution retrospective chart review using a free-text search engine and keywords “osteosarcoma, “lung mets” and “pulmonary mets”, generated 206 patients(pts) diagnosed from 2006-2021. Eligible pts had a diagnosis of lung-only metastatic disease, resection performed at the institution and at least one year of follow-up data. Data was analyzed in two cohorts based on age at OS diagnosis: ped (age&lt;18) and adult (age &gt; 18 years), as well as with age as a continuous predictor. Results: Fifty pts (27F/23M) with lung only mets were eligible for analysis with a median follow up of 10.4 years. Median age was 23 yrs (range 6-77); 20 pts (40% were ≤18 years old); 31 pts (16 ped, 15 adult) had an extremity primary site. Rates of metachronous (67% vs 60%) and bilateral (50% vs 40%) lung mets were similar in ped vs. adult pts, respectively. The median number of lung mets was 2 (range 1 to &gt; 25) with 50% of patients (35) having 2-6 metastases (8 ped, 20 adult). The median size of lung metastasis was 1.2 cm (range 0.1-4.0 cm). 15 ped pts (75%) underwent metastasectomy, compared to 19 adult (63.3%) (OR 1.74, p = 0.39). Probability of metastasectomy decreased with age when used as a continuous predictor (p = 0.11). Ped pts were more likely to have an open procedure as compared to thoracoscopic (OR 12.75, p &lt; 0.01). There was no significant difference in relapse-free survival between ped and adult pts who underwent metastatectomy (p = 0.84). Median overall survival following lung metastasis detection was 5.8 years for ped pts compared to 3 years for adult pts (p = 0.15 from Cox model). Conclusions: Multiple tumor and patient-specific factors affect the decision to undergo metastatectomy in lung-only OS. In our single-center study we learned that timing, pattern, and number of lung mets in ped vs. adult pts were similar, but younger pts were more likely to undergo an open procedure. Our data trended towards a lower chance of undergoing metastatectomy with older age. Larger studies are required to further understand decision-making and therapeutic outcome and a randomized study of open vs. thoracoscopic metastatecomy for lung-only OS mets is underway. In this small study, many patients with lung-only metastatic OS had long-term survival. We showed that relapse-free survival post-metastatecomy was similar in ped and adult patients.
Authorship diversity in global evidence synthesis in genitourinary oncology: A 1998-2022 analysis of cochrane reviews.
Authors: Atulya Aman Khosla, Ahmad Ozair, Nishanth Subash, Abhishek Kumar, Alyssa Pereslete, Sahaam Mirza, Shreyas S Bellur, Rohan Garje, Manmeet Singh Ahluwalia
Journal: Journal of Clinical Oncology (2023)

e23006 Background: Women and individuals from low- and lower-middle-income countries (LMICs) are under-represented in oncology literature, particularly in high-impact publications. LMIC clinicians face multipronged barriers to impactful research. Unlike practice guidelines of oncology societies like ASCO, authors worldwide can potentially contribute to genitourinary (GU) oncology-related Cochrane Reviews, a potentially representative sample of global evidence synthesis efforts in the field. However, the state of authorship diversity here is unknown, which this study sought to determine. Methods: We retrospectively searched the Cochrane Database, using the filter “Topic: Urology”, and extracted authorship data for all reviews related to genitourinary cancers, published until 25 July 2022. We divided authors’ national affiliation into either low- and lower-middle-income countries (LMICs) or non-LMICs based on World Bank 2022 classification. For reviews having collaboratives listed as group authors, we treated the collaborative belonging to one country as a single author, instead of analyzing all collaborators separately to prevent data skew from several included individuals. Given the higher accuracy of manual web-searches for ascertaining gender over algorithmic estimation, we utilized the former to achieve ≥90% ascertainment. We endeavored to capture at least one webpage that demonstrated their gender or pronouns, like institutional profile, and used historical gender conventions. Results: A total of 54 GU oncology-related reviews, co-authored by a total of 324 authors, were included. 53 reviews were published by the Cochrane Urology Group, while one review was published by the Cochrane Incontinence Group. Countries with the highest representation of co-authors were the US (24.1%), UK (25.3%), Germany (23.5%), South Korea (6.8%), Australia (6.2%), Netherlands (3.7%), China (2.8%), Canada (2.5%), Brazil (1.5%). No authors were from LMICs. Gender could be ascertained for 94.14% (N = 305/324) of co-authors. Women made up 27.5% (N = 84/305) of co-authors, 16.0% (N = 8/50) of first authors, and 16.89% (N = 9/53) of corresponding authors. Conclusions: Women authors are better-represented in Cochrane Reviews related to genitourinary cancers compared to urology-specific journals, while LMICs were noted to have no representation. Global capacity-building efforts are warranted for enhancing the involvement of LMIC urologists with evidence synthesis. Equitable authorship representation may help expand both the focus and the utilization of high-impact evidence synthesis literature.
Detecting variation of clonal hematopoiesis using machine-learning in liquid biopsy.
Authors: Yiqun Zhang, Zhihua Pei, Yuting Zhao, Yifan Hu, Zhencong Li, Dongliang Wang, Qiming Zhou
Journal: Journal of Clinical Oncology (2023)

e15027 Background: Tumor‐derived DNA released to the plasma of cancer patients which could be captured and detected by ultra-deep sequencing. NGS provides the technical probability of somatic mutations detection from circulating cell‐free DNA (cfDNA) in plasma samples, while clonal hematopoiesis (CH) mutations affect the accuracy of liquid biopsy for clinical diagnosis or choice of drug and tracing of minimal residual disease (MRD). CH mutation screening of cfDNA samples still an unsolved issue, herein we propose a method that based on multi-variable tree model which screen the CH mutation effectively. Methods: We sequenced 1992 cfDNA (raw depth 35000x) and matched peripheral blood lymphocyte (PBL, raw depth 2000x) samples by 1123 genes target capture sequencing from cohorts which include 962 non-small cell lung cancers (NSCLC), 631 gastric cancers (GC), 379 other non-hematological cancers and 40 healthy normal control. First, we compared the coherence patterns of cfDNA-PBL between CH genes (ASXL1, DNMT3A, TET2) hotspot mutation and tumor associated mutation (EGFR L858R T790M, KRAS G12D G13D, TP53 R43H R141H). Next, we labeled canonical mutations by: point mutation and indels; top frequent tumor genes (from cbioportal collected TCGA cancers); published frequent CH genes; known hotspots and unknown significance genes. Furthermore, hotspot tumor mutation and hotspot CH mutations and other mutations were labeled. kNN classify all mutation to labeled mutations groups, and decided the next steps tree model’s node thresholds build a classify tree model screen the confident CH and somatic mutations. Finally, we validated 6 TP53 CH mutation from healthy normal control by ddPCR. Results: Previous published imbalance test model: 'fisher test p.value &gt; 0.5 &amp; 0.5 &lt; OR &lt; 1.5' only covered 23.2%, 26.9%, 17.5% top 10 hotspot CH mutations (ASXL1, DNMT3A, TET2) correspondingly, while 0.75 quantiles both g_VAF and t_VAF less than 1% and alter reads count less than 20. In terms of tumor associated mutations only 3/155,6/123,7/108,7/71,323/998,16/189 exceed the imbalance test models threshold, especially L858R with median t_VAF 3.4% and t_alter_count 60. Population frequency distribution of CH and tumor genes mutation were different significantly (median 0.776% and 0.569%; p.value &lt; 1.44e-05, F-test). After assign hotspot and CH mutations classify by kNN, The tree model screened 42.9% and 83.6% CH mutations in cancer and healthy normal samples respectively. TP53 were common both in tumor and CH mutation ambiguously, tree model screened 6 TP53 CH mutation (c.12G &gt; A, R43H, G113D, R70C, c.16C &gt; T, A80T) from normal plasma sample all validated by ddPCR. Conclusions: CH mutations were ubiquitous in plasma sample and abundance pattern different from common tumor mutations significantly. CH mutation could be screened by optimal condition assembled decision trees effectively.